ArticleBMC health services research2022
Integrating mental health into primary care: evaluation of the Health Action for Psychiatric Problems In Nigeria including Epilepsy and SubstanceS (HAPPINESS) pilot project.
Article in BMC health services research, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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Who cites it
7 citing papers in PubMed.
- Mental health policy interventions in Nigeria: A scoping review of development, implementation and outcomes.Global mental health (Cambridge, England) · 2026Review
- Mental Health Awareness and Stigma in the General Population: A Mixed-Methods Approach in Semi-Urban Areas.Cureus · 2025Review
- Acceptability and effectiveness of empathy-based provider training and community-level awareness activities on self-injectable contraceptive use in Niger, Lagos, and Oyo States, Nigeria: a mixed methods program evaluation.BMC women's health · 2025Article
- Awareness and involvement of Nigerian Family Physicians in WHO's Mental Health Gap Action Programme: a qualitative study.Discover mental health · 2025Article
- Scaling mental health care in Nigeria: Impact of WHO mhGAP training under the MeHPriC program on knowledge, attitudes, and practices of primary health care workers in Lagos State - A pre-post mixed-methods study.Global mental health (Cambridge, England) · 2025Article
- Mental health care services in Nigeria: A qualitative enquiry from family physicians' perspective.PLOS mental health · 2025Article
- Integrating mental health into primary care in Nigeria: Implementation outcomes and clinical impact of theGlobal mental health (Cambridge, England) · 2024Article
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7 authors.
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Abstract
backgroundThe Health Action for Psychiatric Problems In Nigeria including Epilepsy and SubstanceS (HAPPINESS) project trains non-specialist and primary health care workers in Imo State, Nigeria. This project adapted the World Health Organization's Mental Health Gap Action Programme-Intervention Guide (mhGAP-IG), emphasizing stigma reduction among trainees. This convergent mixed-methods proof-of-concept study evaluates the HAPPINESS pilot project mhGAP-IG training's impact on mental illness stigma among trainees and barriers, facilitators, and opportunities to consider for project improvement.
methodsTrainees (n = 13) completed a 43-item questionnaire before and after their 5-day training to assess perceptions of mental disorders and attitudes towards people with mental illness. These responses were analyzed using paired-sample t-tests for four subscales of the questionnaire: acceptance of socializing with people with mental illness, normalizing activities and relationships with people with mental illness, supernatural causation of mental illness, and endorsement of a biopsychosocial approach to mental illness. Semi-structured key informant interviews (n = 11) with trainees, trainers, and local health officials who participated in or supported the HAPPINESS project were thematically analyzed to understand their experiences and perspectives of the project's barriers, facilitators, and opportunities.
resultsTrainees showed significant improvements on socializing, normalizing, and supernatural causation subscales of the stigma questionnaire (p < 0.05). No significant effect was seen on the biopsychosocial subscale; however, evidence of biopsychosocial beliefs was found in interview responses. Key informant interviews revealed that the HAPPINESS project enhanced trainees' diagnostic and treatment abilities, mental health awareness, and empathy towards patients. Misinformation, stigma, inadequate funding, and lack of road access to clinics were identified as barriers to mental health care integration into general care in Imo State. Respondents also suggested ways that the HAPPINESS project could be improved and expanded in the future.
conclusionsThis study adds to the limited evidence on the implementation of mhGAP-IG in Nigeria. Using mixed methods, it evaluates how mhGAP-IG can impact perceptions and knowledge of stigma among primary care trainees. It also highlights barriers, facilitators, and opportunities to consider for project growth. Future efforts should focus on clinical support, supervision, health outcomes, as well as scaling up and assessing the cost-effectiveness of the HAPPINESS project intervention.
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